2019年浙江省台州市1例新生儿流行性脑脊髓膜炎病例病原学分析

目的对2019年1月浙江省台州市1例流行性脑脊髓膜炎（流脑）病例及密切接触者进行病原学特征分析，为流行病学调查提供分子溯源依据。方法对患者血液标本、脑脊液标本和10名密切接触者的咽拭子进行脑膜炎奈瑟菌分离，对分离菌进行生化、血清分群鉴定以及体外药敏试验，同时采用脉冲场凝胶电泳（PFGE）和多位点序列分型（MLST）进行分子分型分析。结果从患者血液标本和2名密切接触者咽拭子标本中分离到3株脑膜炎奈瑟菌，患者和1名密切接触者的菌株血清群均为B群，另1名密切接触者的菌株为不可分群。 药敏结果显示，3株菌株对头孢呋辛钠、头孢曲松、美洛培南等敏感，对米诺环素不敏感，对环丙沙星和复方新诺明耐药，对青霉素G和氯霉素中介。 PFGE分型显示，3株菌的相似度为100%，MLST均为ST-5664型，属于高致病性ST-4821克隆群。结论台州市人群中存在高致病性ST-4821克隆群B群脑膜炎奈瑟菌，并引起了感染病例，提示应当加强对本地区健康人群携带情况及菌株分子特征的监测，为流脑感染病原菌的溯源调查与控制提供实验室支持。

Etiological analysis of a neonatal meningococcal meningitis case in Taizhou,Zhejiang, 2019

ObjectiveTo understand the molecular epidemiological characteristics of the first neonatal case of ST-4821 complex serogroup B meningococcal disease in Taizhou.MethodsBlood and cerebrospinal fluid samples were collected from the patient and throat swabs were collected from 10 close contacts for pathogen isolation. Biochemical and serogroup identifications were conducted for suspected meningococcal isolates, and the isolate’s drug susceptibility test was conducted, and the strains were subjected to pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST).ResultsThree strains of Neisseria meningitidis were isolated from the patient's blood sample and two close contacts’ throat swabs. The strains from the patient and one close contact belonged to serogroup B, and one strain from another close contact had no serogroup identification results. The drug susceptibility test results showed that the three strains were sensitive to cefuroxime sodium, ceftriaxone, meropenem, not sensitive to minocycline, resistant to ciprofloxacin and cotrimoxazole, and intermediate to penicillin G and chloramphenicol. PFGE typing showed that the similarity of the three strains was 100%, which was probably from the same source. The MLST result indicated that three isolates were all ST-5664 strains, belonging to the highly pathogenic ST-4821 complex.ConclusionHighly pathogenic ST-4821 complex serogroup B Neisseria meningitidis spread in the healthy population of Taizhou, and has caused infection case, suggesting that the surveillance for its carrying status in healthy people and the molecular characteristics of the strains should be strengthened to provide laboratory support for the pathogen tracing and prevention and control of N. meningitides infection.